CCube Solutions has announced that North Bristol NHS Trust has selected its electronic document management software (EDMS) to replace all paper case notes with an easy to use digital system providing instant access to patient medical records for 6,000 clinicians, nursing and administrative staff.
The introduction of EDMS is part of the Trust’s phased Electronic Patient Record (EPR) strategy and will facilitate a more timely and extensive move towards creating a paperlite environment which also involves developing its EPR to reduce the amount of paper created on a daily basis.
This will ensure that one of the largest hospitals in the UK serving people in Bristol, North Somerset and South Gloucestershire is paper free at the point of care – a key NHS England and Government goal. The new EDMS will enhance clinical effectiveness, reduce operational costs, ensure compliance with CQC guidance about records and data management, and ultimately boost patient safety and care.
The choice of CCube Solution’s EDMS will complement and augment the Lorenzo EPR solution – procured from CSC – which was implemented in November 2015.
It is the first contract for CCube Solutions resulting from a new framework agreement with CSC announced in October 2016. This allows CSC to offer CCube’s EDMS to any Trust using Lorenzo who wishes to digitise and display information contained in paper medical records.
Paper creates huge logistical challenges
Currently North Bristol NHS Trust stores about 1.2 million medical folders off-site, with around 850 files being delivered to Southmead Hospital and other premises each day. The paperlite strategy will reduce costs and make the process more efficient.
Neil Darvill, North Bristol NHS Trust’s director of informatics, says, “The business case for the EDMS project is predicated on a scan-on-demand model where only the patient notes for people booked to attend clinic will be processed, not everything in the library. This saves a huge amount of money given the other records will be destroyed in line with our retention policies and procedures as and when they reach their expiry dates.”
Out of its total of 1.2 million folders, the Trust therefore estimates that it has 223,1o0 active patients who will need their records scanning. As each folder contains on average 150 sheets, this means 33,465,000 pages are likely to be scanned in total. The massive back scanning task will be outsourced to a scanning specialist.
Darvill explains, “Our analysis shows that 70% of active patients have follow up appointments after an initial consultation. Once their records are scanned, it means for any subsequent visits, their records are available on the system for clinical staff to see.”
Roll out will be staged with a paperlite project running in parallel
North Bristol NHS Trust is currently piloting EDMS in two areas: lung cancer – a low volume high complexity clinic – and dermatology. This is the reverse – a high volume low complexity department. Based on lessons learnt, it will then adopt a phased approach to rolling out EDMS and scanning the records required – a process expected to take two years finishing in April 2019 given the volume of paperwork to digitize.
In parallel, the Trust is working on a paperlite project to augment the investment in its EPR system. To date, PAS functionality has been successfully implemented within Lorenzo with this now expanding to include real-time data capture. The Trust will customize Lorenzo to its own requirements, tailoring the system to match its own clinical pathways and ways of working.
Darvill explains, “We simply can’t afford to keep generating paper at the pace we are given the number of patients we see – around 1,300 outpatient and 200 inpatient attendances each day. The purpose of the paperlite project is to look at how we capture clinical information immediately at the point of care rather than writing notes on paper and scanning them afterwards as this clearly defeats the purpose of putting in an EPR in the first place.”
Until the paperlite initiative has evolved, so-called ‘day forward’ scanning will be managed in-house. During this period of transition, the Trust has purchased two production scanners from Kodak Alaris – the i4650 and i4850 – which process up to 130 and 150 pages per minute respectively. Kodak Capture Pro imaging software has also been selected which allows large batches of medical paperwork to be captured and indexed quickly and efficiently. It will then be imported into the CCube EDMS.
An EDMS saves money and is simple for clinicians to use
Capital expenditure on the CCube EDMS, Kodak Alaris scanners and capture software along with other implementation costs total £960,000. Over a four-year period, the Trust expects to save over £1.3 million in terms of the operational expenditure associated with the running of its paper-based processes and libraries. The cost savings come from closing the off-site facilities – expected by October 2018.
Vijay Magon, CCube Solutions’ managing director, says, “EDMS in the NHS is all about transformation and presenting information contained on paper to clinicians in a much more efficient and effective way. Ease of use is crucial. Doctors have to be able to interact with the system in front of patients without it creating any unnecessary delays which could make consultations longer. Usability and effectiveness is very important which is what you get with CCube software.”